Marisa Helena Victory, PSY.D., MA, MSW

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20043650B Issued in IN

Practice address

2100 N Main St Ste 304
Crown Point, IN 46307-1877

Phone

(745) 461-9005

Fax

(574) 546-1999

NPI assigned

Mar 24, 2010

Last updated

Dec 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

93.06 of 100Reported as group

Quality

80.07

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

92.91 of 100Reported as group

Quality

79.89

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1902120629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5314 LAUREL CREST RUN",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460627435",
            "telephone_number": "317-678-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N MAIN ST STE 304",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463071877",
            "telephone_number": "745-461-9005",
            "fax_number": "574-546-1999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Research Forest Dr Ste 130",
            "address_purpose": "LOCATION",
            "city": "The Woodlands",
            "state": "TX",
            "postal_code": "773814252",
            "country_code": "US",
            "telephone_number": "281-528-4226",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21 E State St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432154281",
            "country_code": "US",
            "telephone_number": "574-546-1900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICTORY",
        "first_name": "MARISA",
        "middle_name": "HELENA",
        "name_prefix": "Dr.",
        "credential": "PSY.D., MA, MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-24",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "P.08524",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "39154",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043650B",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S.0901121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1201235",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "P.085240",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah E Versluys, DPT
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• Erin Vicari, MD
• Silvia Beatriz Vicente, MD
• Amari Victoria
• Vigilance Anesthesiologists & Pain Specialists PC
• Vigilance Anesthesiologists & Pain Specialists PC
• Jennifer Lee Virgl, NP-C
• Cassandra Visef
• Rhonda Voas, LCSW

• Clinical Psychologist in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.